角 聲 癌 症 關 懷 電 話 癌 症 教 育 講 座 白 血 病 和 淋 巴 瘤 的 治 療 新 知 時 間 : 5/18/2009 星 期 一 加 州 時 間 下 午 7 點 到 8 點 講 員 : 沈 育 民 醫 生 血 液 腫 瘤 科 主 任 醫 生, Parkland Memorial Hospital 美 西 南 醫 學 院 內 科 助 理 教 授, U. T. Southwestern 211 Topaz Street, Milpitas, CA 95035 Tel: (408)263-8585x102 Fax: (408)263-8181 Website: cancer.cchc.org
Leukemia 白 血 病 / 血 癌
Introduction Cancer of blood-forming tissues 造 血 組 織 的 癌 症 Bone marrow 骨 髓 Lymphatic system 淋 巴 系 統 Bone marrow produces a large number of abnormal white blood cells that don t function properly 骨 髓 裡 產 生 不 正 常 的 白 血 球 Affects children and adults 小 孩 大 人 都 可 能 有 Treatment can be complex and intensive; may involve stem cell transplant 治 療 過 程 很 複 雜
Signs and Symptoms Common symptoms 常 見 的 徵 狀 Fevers or chills 發 燒 發 冷 Persistent fatigue, weakness 疲 倦 Frequent infections 慣 性 發 炎 Loss of appetite or weight 沒 胃 口, 體 重 下 降 Swollen lymph nodes, enlarged liver or spleen 淋 巴 腺, 肝 臟, 脾 臟 腫 大 Easy bleeding or bruising 流 血, 瘀 血 Shortness of breath when you are physically active 喘 氣 Tiny red spots on the skin 皮 下 小 出 血 點 Excessive sweating, especially at night 夜 裡 盜 汗 Bone pain or tenderness 骨 頭 疼 痛 May resemble flu or other common illnesses 與 流 感 徵 狀 類 似 Severity depends on number of abnormal blood cells and where they collect
Classification 分 類 Speed of progression Acute leukemia 急 性 白 血 病 Abnormal blood cells are immature (blasts, 裂 殖 胞 ) Can t carry out normal function Multiply rapidly Chronic leukemia 慢 性 白 血 病 Abnormal blood cells are more mature 比 較 成 熟 的 細 胞 Can function normally for some time Multiply slowly Type of cells affected Lymphocytic leukemia: 淋 巴 性 白 血 病 Abnormal cells are lymphoid cells (lymphocytes) which form the lymphatic system (lymph nodes, spleen, tonsils) Myelogenous leukemia: 骨 髓 細 胞 性 白 血 病 Abnormal cells are myeloid cells, which develop into red blood cells, white blood cells and platelets
淋 巴 系 統 骨 髓 細 胞
Major Types 白 血 病 的 種 類 Acute myelogenous leukemia (AML) 急 性 骨 髓 細 胞 性 白 血 病 Most common Affects both children and adults Acute lymphocytic leukemia (ALL) 急 性 淋 巴 性 白 血 病 Most common type young children; 75% of all childhood leukemias Chronic myelogenous leukemia (CML) 慢 性 骨 髓 細 胞 性 白 血 病 Mainly affects adults Associated with Philadelphia chromosome t(9;22) (BCR-ABL) Slow growing phase followed by a rapid growth phase Chronic lymphocytic leukemia (CLL) 慢 性 淋 巴 性 白 血 病 Common in adults; almost never occurs in children More common in Jewish of Russian or Eastern European descent May have no symptoms for years without treatment Others
Causes 原 因 Unclear 不 明. 基 因 和 環 境 因 素 導 致 不 正 常 細 胞 的 發 展 Combination of genetic and environmental factors that lead to abnormal development and growth Results in shortage of normal blood cells 正 常 細 胞 缺 乏 導 致 Infection 感 染 Bleeding 流 血 Anemia 貧 血 Abnormal cells may infiltrate organs 不 正 常 細 胞 侵 襲 Liver 肝 臟 Spleen 脾 臟 Brain 腦 部 Skin 皮 膚 GI tract 腸 胃 系 統
Risk Factors 危 險 因 素 Prior cancer therapy Chemotherapy 化 療 Radiation therapy 電 療 Usually occurs many years after therapy Genetics Down syndrome increases risk 唐 氏 症 Fanconi s anemia 范 康 尼 貧 血 Exposure to radiation and certain chemicals Survivors of atomic bomb or nuclear accidents 核 能 Benzene 苯 Many people get leukemia without risk factors, many with risk factors do not get leukemia
When to Seek Medical Advice 何 時 就 醫 Persistent fatigue, weight loss, easy bruising, bleeding, swollen lymph nodes or fever 持 續 的 疲 倦, 體 重 下 降, 青 腫, 流 血, 淋 巴 腺 腫 大, 發 燒.
Diagnosis 診 斷 Few patients have elevated white blood cell count on routine blood tests without symptoms Diagnostic procedures Blood smear examination to look for abnormal cells 血 塗 抹 檢 查 Immunophenotype to determine the cell type 血 球 計 數 Cytogenetic analysis to look for changes in chromosomes 染 色 體 檢 查 Bone marrow aspiration and biopsy 骨 髓 穿 刺
Treatment 治 療 Chemotherapy 化 學 治 療 Main stay of therapy for leukemia Single or combination of drugs Pills or infusion into veins or cerebrospinal fluid Biological therapy or immunotherapy 生 物 或 免 疫 治 療 Substances that bolster your immune system s response to cancer Kinase inhibitors 摧 化 酶 抑 制 劑 For leukemias with abnormal tyrosine kinases (CML, some ALL and AML) Gleevec, Sprycel, Tasigna Other drug therapy ATRA 視 黃 醇 類 Arsenic 砷 Radiation therapy 電 療 Stem cell (bone marrow) transplant 幹 細 胞 移 植 Clinical trials
Hodgkin s & Non-Hodgkin s Lymphoma 淋 巴 癌
Introduction Cancer of the lymphatic system 淋 巴 系 統 的 腫 瘤 Abnormal cells in the lymphatic system grows and may spread beyond the lymphatic system Body s ability to fight infection is compromised 抵 抗 力 衰 弱 Hodgkin s is named after Thomas Hodgkin, a British physician who first described the disease in 1832 Both Hodgkin s and non-hodgkin s are highly treatable cancer 淋 巴 癌 是 很 容 易 治 療 的 癌 Non-Hodgkin s is 5x more common than Hodgkin s
Signs & Symptoms Many initial signs & symptoms are similar to those of the flu 早 期 徵 兆 和 流 感 很 相 近 Fever 發 燒 Fatigue 疲 倦 Night sweats 夜 裡 盜 汗 Common symptoms Painless swelling of lymph nodes in neck, armpits or groin 淋 巴 腺 腫 大 Unexplained weight loss, >10% of body weight 體 重 下 降 Loss of appetite 失 去 食 慾 Itching 癢 Abdominal pain or swelling 肚 子 腫 脹 Chest pain, coughing or difficulty breathing 胸 部 疼 痛, 咳 嗽, 呼 吸 困 難
Normal and Swollen Lymph Nodes 正 常 與 腫 大 的 淋 巴 腺
Normal Lymph Node
Causes 原 因 Exact cause is unknown 不 明 Hodgkin s lymphoma Abnormal B cells in the lymphatic system called Reed-Sternberg cells 不 正 常 的 B 淋 巴 球 Commonly begins in the upper body and spread contiguously from one lymph node to the next, and eventually any part of the body 傳 遞 式 的 擴 散 Non-Hodgkin s lymphoma Abnormal B or T cells due to activation of certain genes; 85% B cells, 15% T cells 不 正 常 的 B 或 T 淋 巴 球 Generally spreads throughout the body 全 身 的 擴 散
Reed-Sternberg Cell in Hodgkin s Lymphoma
Lymphoma in Various Places
Risk Factors 危 險 因 素 Age 年 齡 15-40 >55 Family history 家 庭 史 Males slightly more likely (Hodgkin s) Infection 某 些 感 染 Epstein-Barr virus (Hodgkin s) Helicobacter pylori (non-hodgkin s) Hepatitis C (non-hodgkin s) Chemicals Pesticides 殺 蟲 劑 Herbicides 殺 草 劑 Compromised immune system 免 疫 系 統 衰 弱
Diagnosis 診 斷 Disease can be difficult to diagnose as early signs are similar to those of other disorders 早 期 徵 狀 和 其 它 疾 病 相 似 Biopsy of enlarged lymph node is needed to make diagnosis 淋 巴 腺 切 片 Other tests X-ray CT/MRI 斷 層 掃 瞄 Gallium or PET scans Bone marrow biopsy 骨 髓 穿 刺 Blood tests
Staging
Treatment 治 療 Factor to consider when deciding on treatment 治 療 前 須 要 考 慮 的 因 素 Your age 年 齡 Your symptoms 徵 狀 Whether you are pregnant 懷 孕 Your overall health status 健 康 狀 況 Radiation for early stage (I or II) 電 療 Chemotherapy 化 療 Immunotherapy and radioimmunotherapy 免 疫 治 療 Stem cell (bone marrow) transplant 幹 細 胞 移 植